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Individual

MIRIAM VITA VAN ALLEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.D.S.

Contact information

Practice address
5920 DEL AMO BLVD, LAKEWOOD, CA 90713-1949
(562) 496-2000
(562) 497-2064
Mailing address
5920 DEL AMO BLVD, LAKEWOOD, CA 90713-1949
(310) 500-9782
(310) 203-9915

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
53958
CA

Other

Enumeration date
11/27/2007
Last updated
11/27/2007
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